This page contains more information about your appointment at the breast clinic.
If you have a new breast symptom your GP will assess you. GPs diagnose and treat many illnesses themselves. However, they may need to refer you to a dedicated breast unit for more specialist care. If you are referred, you will be seen within two weeks at our “New Patient Clinic”. Most patients referred to the breast clinic will not have cancer, but it is important to establish the correct diagnosis for each patient quickly, so that appropriate advice and treatment can be given where needed.
At the New Patient Clinic in the Linda McCartney Centre, we perform as many of the tests as possible that are needed for cancer diagnosis in one clinic visit.
After you have reported to the reception, one of our staff will meet you in the waiting room, take you through into the clinical area and explain to you which further tests you will need.
Several tests may be performed. You may have some or all of the following tests:
If a needle sample is taken, we will make an appointment for you to receive your results – usually within 2 weeks.
For more details of these procedures, see below.
A biopsy is a small operation done to remove tissue from an area of concern in the body. If the clinician feels anything suspicious in your breast, or sees something suspicious on an imaging study, he or she will order a biopsy. The tissue sample is examined to see whether or not cancer cells are present.
This is the least invasive method of biopsy and it usually leaves no scar. A very thin needle is used to get cells for testing. This is a minor and safe procedure. You will be lying down for this procedure. A specialist will use a thin needle with a hollow centre to remove a sample of cells from the suspicious area. In most cases, he or she can feel the lump and guide the needle to the right place. In cases where the lump cannot be felt, they may need to use an ultrasound probe to guide the needle to the right location.
This type of biopsy uses a larger hollow needle than fine needle aspiration does. If the lesion cannot be felt through the skin, the clinician can use an image-guided technique such as ultrasound-guided biopsy or stereotactic needle biopsy. If you have this type of biopsy, you will normally be lying down. After numbing the breast with local anaesthetic, the clinician will use the needle to remove several (approx. 9) samples of tissue from the suspicious area. This type of biopsy will normally not leave a scar. A small metal clip (made of titanium) may be inserted into the breast, at the end of the biopsy procedure to mark the site of the biopsy. If the biopsy is inconclusive and leads to a larger, vacuum assisted biopsy or to surgery, the clip will be removed at that time. If further tests and/or surgery are not required, the clip will be left inside the breast. It is not harmful to the body. It will not set off metal detectors (e.g. at airports) and will not prevent you from having an MRI scan.
This type of biopsy uses the largest biopsy needle. However, unlike a core biopsy (which involves inserting the needle through the skin several times to get the tissue samples) a VAB uses a special probe/needle that is only inserted through the skin once. This type of biopsy also removes more tissue than a core biopsy does. Vacuum assisted biopsies are normally performed using x-ray/mammography guidance, but can also be done under ultrasound guidance. For a VAB, you will normally be lying down. You will be given an injection containing a much larger amount of local anaesthetic to numb your breast. The clinician places the probe into the suspicious area of the breast. A vacuum pump then draws the tissue up, into the probe, removing a larger tissue sample. The probe then rotates, taking further samples, until the suspicious area has been thoroughly sampled. Once again, a small metal clip is normally inserted into the area that has been biopsied, at the end of the procedure
Tissue samples are sent to a tissue expert (pathologist) for examination under a microscope. This is the only way to confirm (without doubt) the presence of cancer.
The doctor or practitioner will tell you the results of any further mammograms and ultrasound scans that you may have had done at the assessment clinic. If a needle sample is taken, we will make an appointment for you to receive your results – usually this is within 2 weeks.
Your appointment may take between 1 to 3 hours. Friends and relatives are asked to wait in the main waiting area while patients wait for their tests in the clinic. This is to respect the privacy of other patients undressed and wearing hospital gowns. However, you may request your friend or relative to accompany you when it’s your turn to see the doctor.
I have been recalled to the Assessment Clinic, following my screening mammogram. Why is this?
Some women may be asked to come for a second visit. This is because their breast x-rays (mammograms) did not give enough information and more detail is needed to help us decide on a result.
After a routine screening mammogram- there are 3 possible outcomes/results:
1. Normal
Your x-rays have shown no signs of cancer and you will be invited again in 3 years’ time for your next routine screen. If you will be over 70 then please contact us for an appointment nearer the time.
2. Technical Repeat
Sometimes the quality of the x-ray does not allow for all the breast tissue to be seen clearly and needs to be repeated for technical reasons only. Approximately 3 out of every 100 women screened will be called back for a technical repeat to get a clearer, more detailed mammogram. You will usually be invited to attend the screening site where you had the initial mammograms performed, although in certain cases it may be necessary to ask you to attend the Breast Unit at the Linda McCartney Centre (at the Royal Liverpool University Hospital) so that your x-rays that need repeating can be checked for their technical quality, before you leave.
3. Assessment
Sometimes the mammograms do not give enough information and a further examination is needed before we can decide on a result. If this is the case you will receive an appointment to attend our ‘Screening Recall/ Breast Assessment Clinic’ at the Breast Unit in the Linda McCartney Centre.
Approximately 5 out of 100 women who have breast screening will be asked to come back to our clinic for a further examination. 4 out of 5 of these women will be found to have a normal result. This additional appointment is part of routine screening and for most women invited back nothing of concern will be found. Any women invited to an assessment clinic will be able to speak to a member of staff by telephone if they want more information before attending.
When you arrive for this visit, a clinician from our specialist multi- disciplinary team will explain what will happen and keep you informed at all stages. The clinician involved at each stage of your appointment will vary. They may include: a surgeon, radiologist, consultant radiographer, advanced practitioner, radiographer, specialist breast care nurse, breast care support nurses, specialist registrars. Other people you may meet there are our radiographic aids (who will assist in your ultrasound examination), medical students and registrars.
It may be necessary to have another mammogram or one or two tests during this visit. When you arrive for this visit, a clinician from our specialist multi- disciplinary team will explain what will happen and keep you informed at all stages. The clinician involved at each stage of your appointment will vary. They may include: a surgeon, radiologist, consultant radiographer, advanced practitioner, radiographer, assistant practitioner, specialist breast care nurse, breast care support nurse, specialist registrar. Other people you may meet there are our radiographic aids (who will assist in your ultrasound examination), medical students and registrars.
How long will I be at the clinic?
Your appointment may take between 1 to 3 hours. Friends and relatives are asked to wait in the main waiting area while patients wait for their tests in the clinic. This is to respect the privacy of other ladies who may be undressed and wearing hospital gowns. However, you may request your friend or relative to accompany you when it’s your turn to see the doctor, for any results.
We appreciate that it may be worrying to be invited for a further appointment, but please remember that the majority of women (4 out of every 5) that come back to this assessment clinic are found to have a normal result.
What happens in the Screening Recall/Assessment clinic?
In these clinics we perform as many of the tests as possible that are needed for cancer diagnosis in one clinic visit.
Several tests may be performed:
If a needle sample is taken, we will make an appointment for you to receive your results – usually within 2 weeks.
For a more detailed of these procedures, see below.
Diagnosis
Tissue samples are sent to a tissue expert (pathologist) for examination under a microscope. This is the only way to confirm (without doubt) the presence of cancer or other abnormalities.
Where do I go?
You will go to the 2nd floor of The Linda McCartney Centre, which is linked to The Royal Liverpool Hospital.
Who gives me the results?
Your results will be discussed with you by a member of the specialist breast team, normally a breast surgeon. There will always be a breast care nurse in the room too and sometimes there may be a medical student present. The surgeon will give you the results and the breast care nurse will be on hand to give you extra information and advice, if necessary. You may require further tests or treatment depending on what the biopsy shows.
Can I have somebody with me?
You are allowed to bring someone in the room with you to get your results. This can be a friend or relative/partner.
What will happen if I get bad news?
Several treatment paths are open to you, if breast cancer is detected.
For more information see our ‘I have been diagnosed with breast cancer’ link.
How soon after getting my results will I receive any treatment I need?
Treatment starts within 31 days of the cancer being diagnosed. A specialist nurse will stay with you for your treatment journey. The nurse is available to answer any questions you may have along the way.